Please use this identifier to cite or link to this item: https://ir.swu.ac.th/jspui/handle/123456789/12747
ชื่อเรื่อง: A noninferiority cluster-randomized controlled trial on antibiotic postprescription review and authorization by trained general pharmacists and infectious disease clinical fellows
ผู้แต่ง: Rattanaumpawan P.
Upapan P.
Thamlikitkul V.
Keywords: cilastatin plus imipenem
meropenem
piperacillin plus tazobactam
prescription drug
antiinfective agent
adult
antibiotic associated colitis
antibiotic postprescription review and authorization
antibiotic prophylaxis
antibiotic therapy
antimicrobial stewardship
bone infection
cardiovascular infection
catheter infection
central nervous system infection
clinical outcome
colitis
community acquired infection
comparative effectiveness
controlled study
drug cost
drug hypersensitivity
drug induced disease
drug response
drug use
drug utilization review
female
gastrointestinal infection
genital tract infection
head and neck infection
hospital infection
hospital mortality
hospital patient
human
infectious arthritis
infectious disease clinical fellow
intervention study
length of stay
major clinical study
male
medical education
middle aged
multicenter study
nose infection
pharmacist
pharyngitis
physician
pneumonia
prescription
randomized controlled trial
Review
skin infection
soft tissue infection
surgical infection
Thailand
treatment response
urinary tract infection
aged
communicable disease
health care facility
health care quality
hospital pharmacy
organization and management
pharmacist
procedures
standards
very elderly
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
Antimicrobial Stewardship
Communicable Diseases
Female
Humans
Male
Middle Aged
Patients' Rooms
Pharmacists
Pharmacy Service, Hospital
Standard of Care
Thailand
วันที่เผยแพร่: 2018
บทคัดย่อ: Objective We compared the effectiveness of antibiotic postprescription review and authorization (PPRA) determined by infectious disease (ID) clinical fellows with that of trained general pharmacists.Methods We conducted a noninferiority cluster-randomized controlled trial in 6 general medical wards at Siriraj Hospital in Bangkok, Thailand. Three wards were randomly assigned to the intervention (ie, the pharmacist PPRA group), and another 3 wards were assigned to the control (ie, the fellow PPRA group). We enrolled all patients in the study wards who received 1 or more doses of the targeted antibiotics: piperacillin/tazobactam, imipenem/cilastatin, and meropenem. The noninferiority margin was 10% for the favorable clinical response and 1.5 defined daily doses (DDDs) for the targeted antibiotics.Results We enrolled 303 patients in the pharmacist PPRA group and 307 patients in the ID fellow PPRA group. The baseline and clinical characteristics were similar in the 2 groups. The difference in the favorable response of patients who received the targeted antibiotics (ie, the pharmacist PPRA group minus the fellow PPRA group) was 5.15% (95% confidence interval [CI], -2.69% to 12.98%); the difference in the DDD of targeted antibiotic use (ie, the pharmacist PPRA group minus the fellow PPRA group) was 0.62 (95% CI, -1.57 to 2.82). We observed no significant difference in the DDD of overall antibiotics, 28-day mortality, 28-day ID-related mortality, favorable microbiological outcome, or antibiotic-associated complications.Conclusions We confirmed the noninferiority of pharmacist PPRA in terms of favorable clinical response; however, noninferiority in targeted antibiotic consumption could not be established. Therefore, using trained general pharmacists rather than ID clinical fellows could be an alternative in a resource-limited setting. Clinical trials registration: clinicaltrials.gov identifier: NCT 01797133 © 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
URI: https://ir.swu.ac.th/jspui/handle/123456789/12747
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85053002289&doi=10.1017%2fice.2018.198&partnerID=40&md5=75e55793c32aed276d014061738c46e3
ISSN: 0899823X
Appears in Collections:Scopus 1983-2021

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